COVID-19 Updates Colorado Department of Health Care Policy & - - PowerPoint PPT Presentation

COVID-19 Updates

Colorado Department of Health Care Policy & Financing

April 10, 2020

1

Colorado Department of Public Health & Environment (CDPHE) Update

• Greg S

chlosser, Branch Chief Update on COVID-19 status in Colorado Crisis Standard of Care

• Dr. Lisa Latts, Chief Medical Officer

Budget Update Progress & Looking Ahead New Department Guidance Issued

• Bonnie S

ilva, Office of Community Living Director Questions/Feedback

• Responses to top question of last week and opportunity for new questions and answers

2

Overview

3

Update

• Personal Protective Equipment (PPE)
• S

tate Emergency Operations Center (S EOC)

• S

urvey priorities - Immediate j eopardy complaints, infection control related concerns

• Medical S

urge Concept of Operations

• Home health & hospice essential services
• S

tate and federal waivers

• HEMS

D COVID-19 Blog

4

Reminder: Personal Protective Equipment

To report issues in

• btaining PPE please

notify:

Sadie Martinez Access and Functional Needs Coordinator Office of Emergency Management 720.610.1691 sadie.martinez@ state.co.us

• HCPF has Dedicated 8 Staff @

25 hours/week

• If you or your organization are experiencing a

shortage or outage of personal protective equipment (masks, gloves, gowns, etc.) to conduct essential or life saving functions during this crisis, please reach out to your local emergency manager or local public health department. Find Your Local Community Emergency Manager Find Your Local Public Health Department

COVID-19 in Colorado

• 6,202 cases
• 1,221 hospitalized
• 226 deaths
• 56 counties
• 58 facilities
• US

: 467K

• Worldwide: 1.62M cases

5

6

Effect of Social Distancing

COVID-19 Crisis Standards of Care

7

CSC Development

• GEEERC with CDPHE develops standards and recommends to the

governor

• Recommendations for Hospitals, PPE, EMS
• Creates liability protection for providers operating under CS

C

• Governor accepts recommendations by Executive Order
• CMO of CDPHE activates executive order
• Has activated PPE and EMS

as of 04/ 10/ 20

• Decisions made by CS

C team – not treating provider

8

EMS,PPE and Hospital CSC

• EMS

:

• Restrict transport and use of services

to most severely ill

• Limit exposure to infection to

protect scarce EMS / PPE resources

• PPE:
• Extended use or limited reuse of

scarce PPE

• Hospitals
• Allow for prioritization of those most

likely to survive given scarce resources

CSC Triage System

• Tiered approach for allocating scarce resources:
• Tier 1 - obj ective blinded triage score - combines measures of severity of

acute illness (the likelihood of surviving weeks) with measures of chronic illness (the likelihood of surviving months to years). In the event of a tie: 2.

• Tier 2 consideration for pediatric patients, healthcare workers, and first
• responders. In the event of a tie: 3.
• Tier 3 special considerations include pregnancy, life-years saved, and the

multiplier effect (e.g. single caregivers). In the event of a tie: 4

• Tier 4 - lottery system for allocation
• Triage decisions will NOT be based on estimated quality of life

10

Budget Update

11

12

Budget Complexities

Changes to Funding

Federal Legislation CMS Authorities 6.2% Enhanced Match S tate Budget S ituation

Progress and Looking Ahead

13

Appendix K

• Staffing Flexibility in Residential S

ettings

• Exclusion of Professional Medical Information Page

(PMIP) at BOTH Annual and Continued S

tate Review

• Retainer Payments for Residential

Disaster S tate Plan Amendment

• Sick Time for CDAS

S Attendants

• Enhanced Payments for Nursing Facilities (NF) &

Intermediate Care Facilities (ICF)

• Waive Level of Care Assessments for NF

Transfers

• Waive PMIP for Home Health, P

ACE, NF , and ICF

• Enhanced Payments for Community Centered

Boards

• Suspend IMD Status
• Staffing Flexibility for NF

, ICF , ACF

• Alternative Location Flexibility for ICF

1135 Waiver

• Waive Signatures for LTS

S Eligibility

• Enhanced Payments for Fiscal Management Services

(FMS)

• Waive S

ervice Every 30-Day Rule

• Allow for Bulk Home Meal Delivery
• Enhanced Payments for Single Entry Points

14

Key Outstanding Federal Approvals

• Added flexibility to most HCBS

benefits for virtual delivery or alternate settings, including certain therapies

• Provided guidance on how to implement telemedicine in

Nursing, Intermediate Care, and Alternative Care Facilities

• Allowed legally responsible person to provide Community

Connector service

15

Implemented Changes

Services

16

In Process and Exploring

Services

In Process

• Allow legally responsible person

to provide previously authorized Homemaker and S upported Community Connector

• Allow a family member or

spouse to provide previously authorized Homemaker and Personal Care

Exploring

• Allow paid sick time for CDAS

S Attendants

• Expand Home Delivered Meals
• Add in-home respite for Community

Mental Health S ervices waiver

• Exceed Y
• uth Day S

ervices limit for Children’s Extensive S upport waiver

• Exceed respite limit
• Enhance payments

• Allowed for virtual assessments
• Changed 100.2 authorization from 6-months to 1-year authorization for

new assessments

• Accept eS

ignatures or snail mail signatures

• Provided guidance on what to do if an agency closes or suspends

services

• Provided guidance on how to document COVID-19 as critical incident
• S

uspended PAS RR for 30 days for new admissions

17

Implemented Changes

Case Management

18

In Process and Exploring

Case Management

In Process

• Additional changes to Professional

Medical Information Page (PMIP) requirements

Exploring

• Allow flexibility on ULTC 100.2 for

individuals transferring between nursing facilities

• Temporary changes to the Notice
• f Adverse Action (803) process

for Case Management Agencies

• Enhanced payments for Case

Management Agencies

• Added flexibility to PAS

RR requirements

• S

uspended Aide supervision requirement for home health agencies

• Modified Nursing Facility staffing requirements
• UPDATED: Allowed for retainer payments for certain HCBS

services

• Provided guidance for what residential providers should do if they

have a suspected or confirmed case of COVID-19

• S

uspended in-person inspections of Host Homes

19

Implemented Changes

Providers and Workforce

20

In Process and Exploring

Providers and Workforce

In Process

• Expand eligible providers across HCBS

waivers and HCA/ Hospice Providers

• Modify Intermediate Care and

Alternative Care Facilities staffing requirements

• Retainer payments for prevocational

and supported employment

Exploring

• Enhanced rates for residential, personal

care, and homemaker services

• Enhanced rates to Nursing and

Intermediate Care Facilities

• Enhanced Financial Management S

ervice (FMS ) payments

• S

uspend IMD status

• Allow for alternative locations for

Nursing and Intermediate Care Facilities

Case Management Agencies

Operational Changes

• OM 20-018 (superseded by OM 20-034, next slides)
• OM 20-019
• OM 20-027

P AS RR Changes

• IM 20-015
• OM 20-030

Critical Incident Reporting for COVID-19

• OM 20-022

HCBS Providers

Long-term Care and Congregate S ettings

• OM 20-017

Day Program S ervice Providers

• IM 20-017 (superseded by OM 20-039, next slides)

HCBS Therapy S ervices

• OM 20-020

Guidance for Program Closures Due to COVID-19

• OM 20-021 (superseded by OM 20-039, next slides)

Guidance for Class B Providers

• OM 20-023

Changes to Benefits & S ervices (Table)

• OM 20-024

Telemedicine

• Temporary Policy

Non-medical Transportation

• OM 20-031

Facilities and P ACE

Infection Control And Prevention of COVID-19 in Nursing Homes (CMS )

• CMS

QS O-20-14-NH Telemedicine in Nursing Facilities

• OM 20-032

21

Previous Guidance

All COVID-19 relat ed memos can be found here: www.colorado.gov/ hcpf/ covid-19-provider-informat ion

New Guidance Issued

22

New Guidance Issued

OM 20-034 OM 20-035 OM 20-036 OM 20-037 OM 20-038 OM 20-039

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All COVID-19 relat ed Memos can be f ound here: www.colorado.gov/ hcpf/ covid-19-provider-inf ormat ion

Updated Authorization Timelines and Documentation

• Initial and Continued Stay Review assessments completed by phone or other electronic modality are

authorized for up to 1 year.

• The member or their legal representative may sign the assessment paperwork by electronic signature,

as outlined in Operational Memo 20-027, or through postal mail.

• For S

IS and ICAP Assessments completed by telephone or other electronic modality, the CMA will document details regarding the administration of the assessment in the Benefits Utilization S ystem (BUS ) log note section. The case manager should complete an in-person review at the next scheduled six- month contact.

• HCBS

assessments that were completed by phone or other electronic modality must receive a face to face visit at their next six-month contact.

• Case Managers will continue to utilize the BUS for Critical Incident Reporting (CIRs) within one

business day of notification as outlined in Operational Memo 20-022.

24

OM 20-034

Supersedes OM 20-018

TITLE: UPDATED CASE MANAGEMENT OPERATIONAL CHANGES IN RESPONSE TO COVID-19

Links: OM 20-034 OM 20-018

S ummary of CDC Guidance to be followed in Residential S ettings if a Resident has a suspected or Confirmed Case of COVID-19

• Contacting resident’s healthcare provider at signs of

symptoms and implementing instructions for medication and care.

• Separate other residents and pets from person,

including bedroom and bathroom use, when possible. When contact is required, use facemasks and other PPE, if available.

• Prohibit visitors who do not have an essential need to

be in the home.

• Ensure shared spaces have good airflow.
• Frequently clean all “ high-touch” surfaces and wash

laundry thoroughly.

25

OM 20-035

TITLE: OPERATIONAL INFORMATION FOR HCBS RESIDENTIAL SERVICES PERTAINING TO COVID19

Link: OM 20-035

Limit Visitors, Outings, and Leaving the Home

• Members and providers should comply with all issued
• rders, such as the Governor’s Executive Order directing

Coloradoans to stay home

• Families, guardians and/ or other natural supports will no

longer be able to take members on community outings or visits outside of the residence unless the families, guardians and/ or other natural supports choose to keep the person in their home for a fourteen (14) day symptom-free quarantine period prior to returning the residence.

• HCPF understands the importance of maintaining contact

and fostering connection with family, friends, and the

• community. HCPF encourages the use of technology to

allow members to connect with their families, guardians and/ or natural supports, or community resources (i.e. ARC Advocate) via video chat (Apple FaceTime or Zoom).

In line with guidance from the federal Centers for Medicare and Medicaid S ervices (CMS ), the Department and Division of Housing (DOH) are suspending all in-person inspections until further notice.

• DOH may continue to conduct inspections of Home Modifications and Home Accessibility Adaptations

through video conferencing, submitted photos, phone calls, and document review, when appropriate.

• DOH will determine the appropriateness of remote inspection. Proj ects not suitable for remote

inspection will be inspected in person at a later date.

• DOH is still available to assist members, providers, and case managers in grievance resolution remotely.
• DOH will resume in-person inspections of IRSS—

Host Home settings at a later date.

26

OM 20-036

TITLE: COVID-19 COMMUNICATION FOR SUSPENDING INPERSON INSPECTIONS FOR HCBS HOME MODIFICATION AND INDIVIDUAL RESIDENTIAL SUPPORT SERVICES— HOST HOME SETTINGS

Link: OM 20-036

CCBs and S EPs shall postpone, or use video or telephone conferencing for the following contractually required meetings:

• Long Range Plan and Annual Public Forum – CCBs
• Board of Directors Meetings - CCBs
• Family S

upport S ervice Program Evaluation and Meeting - CCBs

• Family S

upport Council Meetings – CCBs

• Community Advisory Committee Meetings - S

EPs The Department may extend the deadline on contractually required meetings that cannot be conducted remotely and any associated deliverable by up to 90 days.

27

OM 20-037

TITLE: COMMUNITY CENTERED BOARDS AND SINGLEENTRY POINTS OPERATIONAL CHANGES IN RESPONSE TO COVID-19

Link: OM 20-037

The Department of Health Care Policy and Financing (HCPF), in collaboration with the Colorado Department of Public Health and Environment (CDPHE), is authorizing temporary changes in the training and certification for nurse aides in nursing facilities per the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (retroactive effective date of 3/ 1/ 2020).

• “ CMS

is waiving the requirements at 42 CFR 483.35(d) (with the exception of 42 CFR 483.35(d)(1)(i)), which require that a S NF and NF may not employ anyone for longer than four months unless they met the training and certificat ion requirements under §483.35(d)… ”

28

OM 20-038

TITLE: TEMPORARY TRAINING AND CERTIFICATION OF NURSE AIDES

Link: OM 20-038

For dates of service beginning March 13, 2020, providers delivering the following HCBS services may utilize service delivery alternatives or bill authorized retainer payments (details about how and when included):

• Adult Day S

ervices

• Day Habilitation
• Day Treatment for the Brain Inj ury Waiver
• Prevocational Services (added)
• Supported Employment (added)

29

OM 20-039

Supersedes IM 20-017 & OM 20-021

TITLE: UPDATED HCBS PROVIDER RETAINER PAYMENTSAND CASE MANAGEMENT ACTION REQUIRED FOR CLOSURES RELATED TO COVID-19

Link: OM 20-039

Notes about retainer payments (more details in memo):

• 1. May only be billed when authorized and documented by

case managers

• 2. For units authorized in a member’s service plan, but not

provided due to the COVID-19 pandemic

• 3. Units billed shall not exceed the amount, scope, and

duration otherwise authorized for the S ervice provider

• 4. May not be billed when the member chooses to receive

the service from a different service provider or alternative services in lieu of services identified at left

• 5. Billing requirements outlined in memo linked below

Questions and Answers

30

Case Management Billing Retainer Payments Other Resources

31

Top Topics (Providers + CMAs)

What start date can a Single Entry Point (SEP) provide on a ULTC 100.2 Nursing Facility (NF) certification for new admissions?

For new admissions, S EPs will not need a PAS RR aut horizat ion in order t o issue a cert if icat ion f or NF client s admit t ed on or af t er March 20,

• 2020. The st art dat e of t he cert if icat ion f or init ial admissions shall be

t he dat e t he client admit t ed t o t he NF wit h Medicaid as t he pay

• source. The Depart ment will be issuing an updat ed memo.

32

Case Management

Can a member lose eligibility and be discontinued from HCBS during this current pandemic? No, members cannot lose Medicaid eligibilit y. The Depart ment is working wit h our f ederal part ners t o obt ain addit ional inf ormat ion on t he Maint enance of Ef f ort (MOE) and how it may apply t o HCBS waiver eligibilit y and/ or services. We will share inf ormat ion as it becomes available.

33

Case Management

Can you please confirm that the telehealth location code of "02" is NOT supposed to be applied to HCBS waivers claims? And how long will that be in place?

The Depart ment will be providing guidance next week on how t o ensure appropriat e capt ure of locat ion.

34

Billing

Have you added more services eligible for retainer payments?

• Yes. We have added Prevocat ional S

ervices and S upport ed Employment as eligible services for ret ainer payment s, back-dat ed t o March 13. This is only allowable if t he service was on t he client 's PAR during t his t ime period. S ee Operat ional Memo OM 20-039 for det ails about how t o get ret ainer payment s aut horized and how t o bill.

35

Retainer Payments

Are there resources to help people self-isolate who may not want to or know how?

The Alzheimer’ s Associat ion has t wo online resources t hat might be helpful:

COVID-19 Tips for Dementia Caregivers in Long-Term or Community-Based Settings (Alzheimer’s Association) COVID-19 Tips for Dementia Caregivers (Alzheimer’s Association)

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Other Resources

The Department will continue to work on gathering other helpful resources

• n various topics related to COVID-19. Here are some others we have

gathered this week:

 Emergency Care Plans for Children wit h S

pecial Needs

 Visual guide t o Coronavirus for children wit h aut ism  Anxiet y & Coping wit h t he Coronavirus – Managing worry – Your Kids’ and Your Own  Video – S

elf -care for Direct S ervice Providers in a Crisis

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Other Resources

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The National COVID-Ready Caregiver Certificate Training Program for Frontline Staff

• Provides practical guidance to staff about how to keep themselves and those they care for

safe

• Topics include: infection control practices, personal protective equipment, changes to

health and safety practices, and tips for managing stress and anxiety

• Draws on current CDC and WHO recommendations and guidance
• Features key experts in healthcare and long-term care

https://covidcert.nextstep.careers/ Available through April 17th for free with code: COCOVIDCERT (enter at checkout)

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New Questions?

Stay Engaged

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More Information

Next Steps

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Thank You!

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